Abx prophy for dental procedures are generally not needed for patients with prosthetic joint implants unless there are complicating factors.
Abx prophy for dental procedures is recommended by the AHA/ACC for Infective Endocarditis prophylaxis in those at high risk such as patients with a prosthetic valve (mechanical or bio), other prosthetic material in the heart, hx of IE, unrepaired cyanotic congenital heart disease, or cardiac transplant.
NO for Joints
Abx prophy for dental procedures are generally not needed for patients with prosthetic joint implants unless there are complicating factors.
The 2014 Panel judged that the current best evidence failed to demonstrate an association between dental procedures and prosthetic joint infection (PJI)…..
The 2014 Panel made the following clinical recommendation: In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection. The practitioner and patient should consider possible clinical circumstances that may suggest the presence of a significant medical risk in providing dental care without antibiotic prophylaxis, as well as the known risks of frequent or widespread antibiotic use. As part of the evidence-based approach to care, this clinical recommendation should be integrated with the practitioner’s professional judgment and the patient’s needs and preferences.
The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints – The Journal of the American Dental Association (ada.org)
The authors identified no significant association between IDPs and LPJIs and no effect of AP cover of IDPs in reducing the risk of LPJIs.
In the absence of benefit, the continued use of AP poses an unnecessary risk to patients from adverse drug reactions and to society from the potential of AP to promote development of antibiotic resistance. Dental AP use to prevent LPJIs should, therefore, cease.
Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis – The Journal of the American Dental Association (ada.org)
YES for High Risk Cardiac Conditions
Abx prophy for dental procedures is recommended by the AHA/ACC for Infective Endocarditis prophylaxis in those at high risk such as patients with a prosthetic valve (mechanical or bio), other prosthetic material in the heart, hx of IE, unrepaired cyanotic congenital heart disease, or cardiac transplant.
The risk of developing IE is highest in patients with a prosthetic valve, prior IE, or congenital heart disease with residual flow disturbances.3 IE has been reported to occur after transcatheter aortic valve implantation (TAVI) at rates equal to or exceeding those associated with surgical aortic valve replacement (SAVR) and is associated with a high 1-year mortality rate of 75%.23,24 IE may also occur after valve repair with prosthetic material, which results in high in-hospital and 1-year mortality rates, even with surgical intervention.25,26 IE appears to be more common in heart transplant recipients than in the general population, according to limited data.3
References
- The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints – The Journal of the American Dental Association (ada.org)
- Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis – The Journal of the American Dental Association (ada.org)
- 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines | Circulation (ahajournals.org)
- Prevention of endocarditis: Antibiotic prophylaxis and other measures – UpToDate
- Prosthetic valve endocarditis: Epidemiology, clinical manifestations, and diagnosis – UpToDate
- Antibiotic Prophylaxis Prior to Dental Procedures | American Dental Association (ada.org)
- aae_antibiotic-prophylaxis-2017update.pdf – The American Association of Endodontists